Insulin and Carbohydrate balance for an insulin dependent low carber

Just for discussion and sharing - diabetes mellitus (Type 1, Type 2, Gestational, etc) , the Hallmark or medical definition is high blood sugar.

A non-diabetic person has a blood glucose level of 4.7mmol/l, the medical doctors are aware of this fact. Based on this fact for an average person of about 70kg will have about 5 to 5.5 litres of blood. 5mmol/l converted to mg/dl will be 90mg/decilitre. 90mg x 5.5/0.1 = 4950mg which is approximately 5grams with a little wiggle room will be 4.5 to 5.5grams of glucose.

For a non-diabetic person, where the blood glucose has increased due to ingestion of glucose/ starch or table sugar will trigger release of insulin from pancreas to bring blood glucose down to the 5grams state. However if you are diabetic you do not have the phase one insulin to neutralise the excess glucose going into the blood, phase two insulin will take hours to come in and remember blood glucose higher than the baseline will cause damage to the body in the long run.

So if you are a diabetic like me who is on low carb diet, the bolus regular insulin which I injected for protein meal is only about 7 units, which will work for 5 hours and neutralised the protein meal which also takes about 5 hours to completely digest. The may be some inbalance either slightly more insulin or slightly more protein. If protein is slightly more the blood glucose will be slightly elevated to 6.5mmol/l. If the insulin is slightly more, the blood glucose will be 3.5 to 4mmol/l, so in this case, the remedy is one gram of glucose which will rapidly bring the blood glucose to 4.5mmol/l. THat is how I get to maintain my HBa1c at around 5%.

The advice of taking 10grams of glucose in my case will rapidly raise my blood glucose to 13mmol which is very bad for me. However for those taking 15 units of Novorapid for starchy food, there is always a chance of having too much insulin due the variability of starches in food (officially 10% difference is allowed as stated in the nutrition facts). Mismatch in insulin and food is therefore very common, hypos are bad, so the 'safe' advice is to take 10 to 15grams of quick acting sugar to relieve the hypo. Just check the blood glucose one hour after ingesting the 10 or 15grams of sugar, also check how long the high blood glucose persist!

All long term complications, neuropathy (due to high blood glucose attacking the nerves), nephropathy (due to high blood glucose damaging the nephrons in the kidneys), retinopathy (due to high blood glucose damaging the retina), glycation of protein collagen leading to frozen shoulders, etc can be avoided where blood glucose can be maintained at non-diabetic level which is between 4mmol/l to 6mmol/l but should be at or just below 5mmol/l.

I am not selling anything for Dr Berstein - the manwho lives and breathes diabetes since age 12 and is about 90 years old now. Just read and mastered the Complete Diabetes Solution to master the blood glucose issue.

Hi EllieM

My diabetes DM2 was 'well controlled' at about 6.2% on Glucophage XR 500mg x 3 per day and with low carb - before getting my RCA closing on one morning in Dec 2018. The doctors (endocrinologist) refused to give me insulin to better manage my blood glucose. (They are worried of me getting hypos and having to answer for it)

In Nov/Dec 2018, I somehow knew that my coronary arteries are closing up as walking for 400m get me breathless, although I can still do some bench presses slowly. (In 2014 a coronary angiogram shows that my LAD is 70% blocked).

Knowing that stenting requires contrast to show the blockages in the arteries and these contrast injections must be cleared by the kidneys, metformin had to be stopped at least 3 days before the angiogram, otherwise the patient had to undergo dialysis immediately after the stenting to flush out the contrast. I stop the metformin and gone on water fast for a week but on the fourth day the searing pains starts and I went to A & E for emergency treatment. (Fasting BG 5.0mmol/l and HbA1c 5.6 as they let me know later.) I told them I am diabetic, the docs don't believe and wanted to dose me with dextrose5% to bring down the ketone bodies which according to lab is greater than 6mmol, (only up to 6mmol is measurable in the lab.) I had to invoke Informed Consent to stop the young doctor to stop trying to dose me with the dextrose.

Later I managed to get the cardiologist to gave me Actrapid or Human insulin to bring down my BG which had shoot up to 9mmol/l. and my ketones rises to 6mmol/l.

When I went back to endocrine, I told the associate consultant that I want to go on insulin therapy and no more metformin. Because metformin is predominately cleared by kidneys and I also do not want the sulfonylureas as they burnt out the remaining beta cells from one to three years of use. (She gave me the insulin as someone in cardiology initiate insulin not her.)

(You can get the info on metformin by googling metformin package insert to read the relevant info which is bad for elderly.)

Everybody is entitled to their opinion and thinking as to what is an acceptable BG range in a healthy body. I had observed women (in their 40s) eating carnivore diet whos BG remains 80mg/dl before, during and after the meal, they hardly look like 30s. One example is Kelly Hogan: carnivore for 13 years ( ).

There are also no diabetic animals in the wild whether predators or preys (carnivores or grazers) they do not eat starchy carbs whole year round. Only animals adopted by humans developed diabetes (we gave them starches). Human has 5x the size of the the animals beta cells which enable humans to eat a lot more starchy carbs but is it healthy I do not know.

Recently I had some kidney stones and to clear it I went on a seven days water fast, the bolus insulin was stopped on the first day and after the third day the basal insulin was also stopped and the BG is always between 3.6 to 4.4 mmol/l. So I am a Type 2. I had also read somewhere when you are fasting and running on ketone bodies and fat, the BG can be as low as 2.8 mmol/l without feeling hypo.

I had been adopting Dr Berstein's broad principle of normalising BG and dosing physiologic dose of insulin - interpreted as the optimal dose as though it is done by the body glucose regulator. If you can feel hypoglycemic while walking only (not vigorous exercise) it is possible that your basal insulin is on the high side. You may like to fast for a day and adjust your basal insulin lower by 10% and measure your BG throughout the day, the BG should remain 4.5 to 5.5 mmol/l and that is the correct basal dose.

I am always skeptical of those nutritional advise but some of the figure quote may be facts e.g a man requires 2200 kcals a day, that can be measured by calorimeter but it doesn't mean that you need to eat 550 kcals of carbs in one meal.

For ease of computation, assume each man uses or requires 2400 kcals per day, that will be 100 kcal per hour, if it is all carbs or starches it will be 100/4 = 25grams of starches per hour (1 gram of carb produces 4kcal).

We do not allowed more than 5 grams of glucose in the blood so these 25 grams will have to be release from glycogen stored in the liver and muscles so that no toxicity will occur.

So if we are to eat 50 grams of starches - it will hit the blood in 2 mins or 30 mins depending on the refined states of these starches almost all at one go or say 80% i.e. 40 grams will hit the blood at one go and then insulin will need to shunt the glucose into liver, muscles or stored as fat when glycogen is full. If we are continuously eating 500 grams of starches 3 times a day, we will be storing fat for winter (famine), but famine never comes in the modern world and that is why in human population eating carbs as main dish - one out of three aged 65 is diabetic and two out of three aged 70 are diabetic.

The amount of insulin to use is by trial and error, regular insulin or crystalline insulin last about 5hours which more or less matches protein digestion. Starches hit the blood too fast for injected insulin to match it. Most of the time when my BF goes up to 7mmol/l I will inject 4units of regular by intramuscular (12.7mm syringe) injection and this will correct the overshoot in 30 mins and complete in two hours due to the left over protein emptying into the intestine and also because of my insulin resistance. I had to emphasize that everyone is different and need to titrate accordingly.

I usually learn things about nutrition from those who have no horse in the race, e.g. to learn about fat go to learn from Credit Suisse not from those with conflict of interest https://www.credit-suisse.com/about...rtise/fat-the-new-health-paradigm-201509.html

To learn about ketosis read from Dr Annette Bosworth:
ANYWAY YOU CAN: Doctor Bosworth Shares Her Mom's Cancer Journey: A BEGINNER’S GUIDE TO KETONES FOR LIFE

Happy reading - as I had decided that my health should be decided by me based on unbiased information.

Hi bulkbiker

I am on a carnivore diet - zero carbs not even vegetables, if that is not extremely low carb then I don't know what is low carb. Some of the protein will converts to glucose due to gluconeogenesis and also the there is the dawn phenomena and the incretin effect where bulk will trigger glucose spike..

Remember diabetes is a continuum where many people assume that Type 2s are always producing excess endogenous insulin and getting diabetes due to insulin resistance. Yes that is at the beginning and when diagnosed with overt diabetes, usually 65% to 80% of the beta cells are already gone. There is nothing odd there, the matter of prescribing insulin therapy was referred to the division head who is a Professor of Medicine (Endocrine) and I was interviewed (or rather grilled) for half an hour before I can get all the necessary insulin.

I had been on no carbs diet for many years but the spike after meals and due to dawn phenomena continues to damage my beta cells such that I had no phase one insulin.

Using these physiologic doses of insulin enable fine tuning of BG with minimal effort and cost. Remember everyone is different. If you know how to master the insulin glucose dynamics, insulin therapy has an advantage where it allows you to deal with sudden BG spikes due to infection, etc.